Provider Demographics
NPI:1518935923
Name:BURLINGTON CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:BURLINGTON CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-754-5751
Mailing Address - Street 1:2930 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1616
Mailing Address - Country:US
Mailing Address - Phone:319-754-5751
Mailing Address - Fax:319-758-6479
Practice Address - Street 1:2930 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1616
Practice Address - Country:US
Practice Address - Phone:319-754-5751
Practice Address - Fax:319-758-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0024927Medicaid
IA0024927Medicaid
T00308Medicare UPIN